AQI 80 · Continuation of Buprenorphine for Inpatient Surgical Patients, or Methadone Therapy during the Perioperative Period

Steward: American Society of Anesthesiologists / Anesthesia Quality Institute | First Performance Year: 2026 2026 Status: NEW. Approved by CMS as a new QCDR measure for the 2026 MIPS performance period. Replaces the retired AQI 74 (methadone) and AQI 75 (buprenorphine), which were combined into this single measure.

MEASURE DESCRIPTION

Percentage of patients age 13 and older undergoing an inpatient surgical procedure who have an outpatient prescription for buprenorphine/naloxone or suboxone in their admissions documentation and who are continued on buprenorphine for the duration of their inpatient stay; or undergoing an inpatient or ambulatory surgical procedure who are taking methadone as outpatients or who have a prescription for methadone in their admittance documentation, and where methadone is either continued or changed to an equivalent IV dose to maintain the therapeutic level regimen during the perioperative period. For patients receiving care in an ambulatory surgical setting, methadone medication was provided as scheduled before surgery.

This measure consists of two performance rates:

Measure A: Percentage of patients age 13 and older undergoing an inpatient surgical procedure who have an outpatient prescription for buprenorphine/naloxone or suboxone in their admissions documentation and are continued on buprenorphine for the duration of their inpatient stay.

Measure B: Percentage of patients age 13 and older undergoing an inpatient or ambulatory surgical procedure who are taking methadone as outpatients or have a prescription for methadone in their admittance documentation, and where methadone is either continued or changed to an equivalent IV dose to maintain the therapeutic level regimen during the perioperative period. In an ambulatory setting, methadone was provided as scheduled before surgery.

NOTE: The overall measure score is calculated as a simple average of the performance rates of A and B. To be scored, clinicians must have at least one eligible case reported for each sub-metric.

NQS DOMAIN / MEANINGFUL MEASURES AREA

Opioid Related

MEASURE TYPE: Process HIGH PRIORITY STATUS: Yes | HIGH PRIORITY TYPE: Opioid-related INVERSE MEASURE: No | RISK ADJUSTED: No NUMBER OF PERFORMANCE RATES: 2, simple average CARE SETTING: Ambulatory, Ambulatory Surgical Center, Hospital, Hospital Inpatient, Hospital Outpatient, Office Based Surgery Center TELEHEALTH: No DATA SOURCE: Administrative claims data, claims, EHR, paper medical record, record review, registry

2026 BENCHMARK

No historical benchmark. Measure added in PY 2026. Subject to a 7-point scoring floor if data completeness is met.

Practical implication: AQI 80’s first-year scoring floor is subject to data completeness. Confirm that the measure fits your case population and that both sub-metrics meet their reporting requirements before including it in your submission.

Testing requirement note: CMS approved this measure conditionally. For the 2027 self-nomination, empirical validity, measure score reliability, feasibility, and patient/encounter-level data element testing will be required.

INSTRUCTIONS

Submit data on one of the submission criteria depending on the clinical findings and surgical setting. If the patient has an outpatient prescription for buprenorphine/naloxone in their admissions documentation for an inpatient surgical procedure, use Measure A. If the patient is taking methadone as an outpatient, has a prescription for methadone in their admittance documentation, or methadone is provided as scheduled before an ambulatory surgical procedure, use Measure B.

There is no diagnosis associated with this measure.

Measure A: Buprenorphine Continuation (Inpatient)

DENOMINATOR

Patients aged 13 years and older undergoing any inpatient surgical procedure who have a prescription for buprenorphine/naloxone or suboxone in their admitting documentation.

Denominator Criteria (Eligible Cases): - Patients aged 13 years and older - AND Patient encounter during the reporting period matching the measure's ASA anesthesia CPT list (266 codes; the full list appears at the end of this measure) - AND Place of service code 21 (Inpatient Hospital) - AND Patient has a prescription for buprenorphine/naloxone or suboxone in their admitting documentation (12A17)

DENOMINATOR EXCLUSIONS

- Patient has a chronic pain diagnosis (ICD G89.4, or registry code 12A18)

NUMERATOR

All patients who receive a continuation of buprenorphine during their inpatient stay.

Performance Met: 12A19 The patient received a continuation of buprenorphine during their inpatient stay OR Denominator Exception: 12A20 Documentation that the inpatient is unable to tolerate buprenorphine, received instruction from their surgical, anesthesia, and/or addiction treatment provider to stop buprenorphine prior to the inpatient procedure, refused continuation of buprenorphine treatment, or received methadone in lieu of buprenorphine OR Performance Not Met: 12A21 The patient did NOT receive a continuation of buprenorphine during their inpatient stay

Measure B: Methadone Continuation (Inpatient or Ambulatory)

DENOMINATOR

Patients aged 13 years and older undergoing an inpatient or ambulatory surgical procedure who are taking methadone as outpatients or who have a prescription for methadone in their admittance or ambulatory surgical documentation.

Denominator Criteria (Eligible Cases): - Patients aged 13 years and older - AND Patient encounter during the reporting period matching the measure's ASA anesthesia CPT list (266 codes; the full list appears at the end of this measure) - AND Place of service code 19, 21, 22, or 24 - AND Patient is taking methadone as an outpatient or has a prescription for methadone in their admittance documentation (12A27)

DENOMINATOR EXCLUSIONS

None.

NUMERATOR

All patients where methadone is either continued or changed to an equivalent IV dose to maintain the therapeutic level regimen during the perioperative period, or, if in an ambulatory setting, was provided as scheduled prior to surgery.

Numerator Note: In the inpatient setting, methadone may either be continued or changed to an equivalent IV dose to maintain therapeutic levels. Documentation of methadone provided as scheduled prior to surgery in the ambulatory setting is acceptable.

Numerator Note: For this measure, the perioperative period includes the preoperative, intraoperative, and postoperative periods. The postoperative period ends when the patient is discharged from the PACU or recovery location.

Performance Met: 12A28 Methadone therapy is continued or changed to an equivalent IV dose to maintain the therapeutic level regimen during the perioperative period, or in an ambulatory setting methadone was provided as scheduled prior to surgery OR Denominator Exception: 12A29 Documentation that the patient received instruction from their surgical, anesthesia, and addiction treatment provider to stop methadone prior to the procedure; or documentation of medical reasons for not continuing or changing to an equivalent IV dose during the perioperative period, or for methadone not being provided as scheduled in an ambulatory setting. Medical reasons may include patient transfer to intensive care, a diagnosis of hypotension or shock, unstable plasma levels, or inability to tolerate the daily methadone regimen OR Performance Not Met: 12A30 Methadone therapy is NOT continued or changed to an equivalent IV dose during the perioperative period, or in an ambulatory setting methadone was NOT provided as scheduled prior to surgery

RATIONALE

According to multiple studies and guidelines, buprenorphine should not be routinely discontinued in the perioperative setting. Hospitalization presents an opportunity for anesthesiologists and pain medicine physicians to ensure patients already under opioid use disorder treatment have their therapy continued during their inpatient stay. Surgeons, anesthesiologists, and addiction medicine providers may also use the opportunity to identify patients at risk for opioid use disorder. Recommendations developed by a multispecialty expert panel including representatives from ASRA, ASA, the American Academy of Pain Medicine, the American Society of Addiction Medicine, and the American Society of Health System Pharmacists note that anesthesiologists and pain physicians can recommend and consider initiating medication treatment of opioid use disorder in patients with suspected OUD at the point of care, which can serve as a bridge to comprehensive treatment.

Barreveld describes hospitalization as a patient-centered opportunity for shared decision-making and expectation discussions, calling it essential to all medication-for-OUD strategies when managing acute surgical pain, and notes that prevailing consensus-based recommendations advise continuation of methadone and buprenorphine without interruption throughout the perioperative period.

CLINICAL PRACTICE RECOMMENDATIONS

American Society of Addiction Medicine, National Practice Guideline for the Treatment of Opioid Use Disorder, 2020 Focused Update: Discontinuation of methadone or buprenorphine before surgery is not required. Higher potency intravenous full agonist opioids can be used perioperatively for analgesia. If it is decided that buprenorphine or methadone should be discontinued before a planned surgery, this may occur the day before or the day of surgery based on surgical and anesthesia team recommendations. Methadone or buprenorphine can be resumed postoperatively when the need for full opioid agonist analgesia has resolved. In general, pre-surgery daily doses can be resumed if withheld for less than 2 to 3 days.

Buprenorphine Management in the Perioperative Period: Educational Review and Recommendations from a Multisociety Expert Panel, 2021: Continuation of buprenorphine in the perioperative period is supported by evidence that discontinuation is harmful, and for some patients discontinuation may be fatal. The likelihood of harm is increased in patients prescribed buprenorphine for OUD as opposed to chronic pain.

REFERENCES

1. Barreveld AM, Mendelson A, Deiling B, Armstrong CA, Viscusi ER, Kohan LR. Caring for Our Patients With Opioid Use Disorder in the Perioperative Period: A Guide for the Anesthesiologist. Anesth Analg 2023;137(3):488-507. PMID: 37590794 2. Jimenez Ruiz F, Warner NS, Acampora G, Coleman JR, Kohan L. Substance Use Disorders: Basic Overview for the Anesthesiologist. Anesth Analg 2023;137(3):508-520. PMID: 37590795 3. Kohan L, Potru S, Barreveld AM, et al. Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel. Reg Anesth Pain Med 2021;46(10):840-859. PMID: 34385292 4. Moran S, Isa J, Steinemann S. Perioperative management in the patient with substance abuse. Surg Clin North Am 2015;95(2):417-28. PMID: 25814115 5. Sutherland AM, Clarke HA. The role of anesthesiologists in reducing opioid harm. Can J Anaesth 2022;69(8):917-922. PMID: 35773601

RELEVANT FIELDS (Graphium capture)

- Date of procedure, date of birth (note: age 13 and older, not 18) - ASA CPT code - Place of service code - Buprenorphine/naloxone or suboxone prescription in admitting documentation - Methadone use or prescription in admittance documentation - Chronic pain diagnosis (G89.4) - Buprenorphine continued during inpatient stay - Methadone continued or converted to equivalent IV dose - Methadone provided as scheduled prior to ambulatory surgery - Documented reason for discontinuation

REPORTING CODES

DENOMINATOR CPT CODES

A case must carry one of the codes below to enter this measure's denominator. The other denominator criteria above still apply - a matching code makes a case eligible for consideration, not automatically countable.

266 anesthesia CPT codes:

Source: 2026 AQI NACOR QCDR Measure Book. CPT copyright American Medical Association.